Pretreatment serum levels of lactate dehydrogenase (LD) and beta-2-microglobulin correlate with both the time to treatment failure and the survival seen in patients with diffuse large cell non-Hodgkin's malignant lymphoma. Three prognostic groups (low risk, intermediate risk, high risk) could be identified based upon the serum levels of these 2 analytes.


Treatment protocol:

(1) Alternating CHOP-Bleo (cyclophosphamide, doxorubicin, vincristine, prednisone and bleomycin) with VP-16 (cyclophosphamide, methotrexate, etoposide) and dexamethasone.

(2) Patients previously untreated.

(3) Tumors included: diffuse large cell, immunoblastic lymphoma, diffuse mixed-cell, diffuse small cleaved cell

(4) Tumors not included: low grade lymphoblastic lymphoma, high grade lymphoblastic lymphoma, undifferentiated lymphoma


Definition of high tumor burden:

(1) bulky nodal area = palpable abdominal mass, nodal area > 7 cm, concomitant pelvic and paraaortic adenopathy, mediastinal mass, or head and neck lesion T3 or T4

(2) 2 or more bulky nodal areas

(3) 3 extranodal areas of involvement

(4) 2 extranodal and one bulky area


Factors found on univariate analysis to correlate with time to treatment failure

(1) beta-2-microglobulin: correlated with tumor burden

(2) lactate dehydrogenase (LD): did not correlate with tumor burden

(3) Ann Arbor stage

(4) tumor burden

(5) B clinical symptoms

(6) extranodal disease


Factors identified on multivariate analysis as independent predictors of time to treatment failure:

(1) beta-2-microglobulin (since beta-2-microglobulin is excreted by the kidney, renal failure could result in elevated serum levels unrelated to tumor burden)

(2) LD


Upper limits of normal for analytes:

(1) beta-2-microglobulin: 2 mg/L

(2) LD: 225 U/L

Risk Group

Serum LD

Serum beta-2-Microglobulin


low (< 250 U/L)

low (< 3 mg/L)


increased (>= 250 U/L)

low (< 3 mg/L)


low (< 250 U/L)

increased (>= 3 mg/L)


increased (>= 250 U/L)

increased (>= 3 mg/L)



Patient Outcome

low risk


high risk

complete response to therapy




relapse within 24 months if initial complete responder


0% with low ß2m; 25% with high


no evidence of disease progression at 24 months for all patients




survival at 24 months





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